The present invention relates to an improved apparatus and method for the intubation of catheters, and, in particular, to a cylindrical, inflatable sheath having a closed, rounded tip that is inserted through the catheter and inflated adjacent the distal tip of the catheter prior to intubation, the cylindrical sheath being deflated and withdrawn following intubation.
A wide variety of catheters are available to the practising physician for intubation into the different passageways of a patient, as the need arises. Catheters vary in size, length, type and texture of material of which they are composed.
Of importance to the anesthesiologist is the class of catheter known in the art as endotracheal tubes designed for intubation into the trachea of a patient prior to anesthesia. Endotracheal tubes may be of the cuffed or uncuffed type, the uncuffed type being a smooth, long, hollow, pliable tube having open proximal and distal ends. The conventional cuffed endotracheal tube is provided with an inflatable cuff or balloon surrounding the outside distal end portion of the tube at a position above the distal tip. The ends of the cuff are secured to the outside wall of the tube to provide an airtight seal between the outside wall and the inside of the cuff. After intubation of a cuffed tube, the cuff is expanded by applying air under pressure to assure that the outside wall of the cuff embraces the trachea of the patient.
The distal tip or end of conventional catheters and endotracheal tubes is usually beveled at an angle which may vary between thirty to sixty degrees, depending, in part, upon the type of catheter to be used. In addition to the beveled distal tip, certain catheters and endotracheal tubes may have a small side or lateral opening through the side wall of the catheter at the distal end portion of the tube just above the beveled tip. This latter design is referred to in the art as a Murphy tip.
Intubation of the endotracheal tube, whether cuffed or uncuffed, may be accomplished either by inserting and passing the distal end portion through the patient's mouth and down into the trachea or, under certain conditions, by inserting and passing the distal end portion through the patient's nasal passageway past the pharynx and down into the trachea. In the former case, the endotracheal tube may be of a size and type identified as an oral, endotracheal tube. Endotracheal tubes, identified as either oral or nasal, may be intubated through the mouth or through the nose of the patient.
The intubation of catheters and endotracheal tubes is not without its problems. To aid the intubation of oral endotracheal tubes, the anesthesiologist may employ a catheter guide or stylette inserted within the endotracheal tube prior to intubation to enable the physician to shape the endotracheal tube, provide additional structural rigidity to the tube and afford an improved means for gripping and maneuvering the tube to accomplish intubation. My prior U.S. Pat. Nos. 3,957,055 and 4,185,639 pertain to improvements in the intubation of catheters and endotracheal tubes.
An additional type of catheter, of importance to the physician, is the nasal catheter designed to intubate the nasopharyngeal airway to insure that a patient may breathe satisfactorily when the condition of the patient's mouth prohibits oral intubation. The conventional nasal catheter is relatively short, is composed of highly flexible and pliable material, has a beveled, distal, open tip and a flared, open proximal end. Nasal catheters vary in size from six to eight and one-half millimeters. Due to the highly sensitive and delicate nature of the membranes of the nasopharyngeal airway, the intubation of nasal catheters and nasal endotracheal tubes has been known to cause trauma and injury to the patient. To minimize injury, the outer cylindrical surface of nasal catheters is textured, or frosted, and the surface lubricated to aid intubation. The wall thickness of the nasal catheter, generally, is less than that of endotracheal tubes, and the nasal catheter is pre-shaped, or curved, in an attempt to reduce injury and to aid intubation.
The present invention is directed to improvements in the intubation of catheters and endotracheal tubes, and especially to the intubation of nasal-type catheters. A soft, inflatable introducer, having a closed, rounded, distal-tipped sheath, is inserted into the open proximal end of and through a hollow, cylindrical catheter or endotracheal tube, with the distal-tipped sheath protruding partway beyond the open distal end of the catheter. The distal-tipped sheath is inflated, prior to intubation, to a diameter equal to or slightly larger than the outer diameter of the catheter. Both catheter and introducer are intubated into and through the passageway of the patient. The inflated sheath serves not only as a guide but also as a soft and flexible opener or enlarger of the sensitive membranes within the passageway, thereby enabling the catheter to penetrate and negotiate the varied shapes, obstacles or bends encountered. After the catheter has been successfully intubated within the passageway, the distal-tipped sheath is deflated and the introducer is withdrawn.
Accordingly, a principal object of the present invention is to provide an improved method and apparatus for the intubation of catheters which reduce trauma and injury to the patient.
Another object is to provide a soft, closed, inflatable sheath that may be placed ahead of the open distal tip of a catheter to guide the catheter into the passageway of a patient during intubation.
Still another object is to provide an improved catheter and inflatable introducer combination which enables the physician to more readily intubate the catheter, after which the introducer is deflated and removed.
An important object is to provide an improved procedure for the intubation of nasal catheters and endotracheal tubes into the nasopharyngeal airway of a patient.
The above objects of and the brief introduction to the present invention will be more fully understood, and further objects and advantages will become apparent, from a study of the following detailed description in connection with the drawings.